Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trial
Background. Secondary postoperative diffuse peritonitis (SPDP) associates with a high incidence of abdominal sepsis and 35–92% mortality rate. An optimal surgical doctrine in this complication in lacking to date.Objectives. An efficacy assessment of vacuum-assisted laparostomy (VAL) with staged lavag...
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| Format: | Article |
| Language: | Russian |
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Ministry of Healthcare of the Russian Federation. “Kuban State Medical University”
2022-02-01
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| Series: | Кубанский научный медицинский вестник |
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| Online Access: | https://ksma.elpub.ru/jour/article/view/2629 |
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| author | I. B. Uvarov D. D. Sichinava A. M. Manuilov |
| author_facet | I. B. Uvarov D. D. Sichinava A. M. Manuilov |
| author_sort | I. B. Uvarov |
| collection | DOAJ |
| description | Background. Secondary postoperative diffuse peritonitis (SPDP) associates with a high incidence of abdominal sepsis and 35–92% mortality rate. An optimal surgical doctrine in this complication in lacking to date.Objectives. An efficacy assessment of vacuum-assisted laparostomy (VAL) with staged lavage relative to relaparotomy on demand (RD) in SPDP patients.Methods. Patient enrolment and analyses were conducted within period 01.11.2017-31.12.2020, totalling for 141 SPDP patients, 77 (54.6%) males and 64 (45.4%) females aged 64.5 (5972.7) years. Cohort I patients (n = 52) had post-abdominal-lavage VAL using Suprasorb® SNP (SNP-1 and SNP-2) equipment and consumables (Lohmann & Rauscher GmbH, Austria). Staged lavage was performed 48-72 h apart. Cohort II (n = 78) had a standard RD technique. Cohort III (n = 11) treatment included RD-to-VAL transition. The endpoint was the inpatient treatment outcome, a favourable completion or death. The additional estimated criteria were complications rate and severity (in ACCORDION-modified Clavien-Dindo classification), sepsis rate, C-reactive protein level, abdominal index dynamics, patient’s intensive-care and total-hospital lengths of stay.Results. Cohort I included 157 staged-lavage VALs, cohort II — 107 RDs, cohort III — 49 operations. The mortality rate was 3/52 (5.8%), 24/78 (30.8%) and 7/11 (63.6%) in cohorts I, II and III (respectively, p < 0.001). No difference was observed in the length of hospital stay, with a shorter intensive care stay after final abdominal closure in cohort I. Clavien — Dindo grade 3a complications were observed for 25.0% of cohort I, 60.3 and 45.5% — of cohorts II and III (respectively, p < 0.01); grade 3b complications were 0 (0%), 24.4 and 100% in cohorts I, II and III (respectively, p < 0.001; all 11 patients were reoperated). Multiple organ failure (grade 4b) was reported in 5.8, 30.8 and 63.6% of cohorts I, II and III (respectively, p < 0.001). By end of treatment, sepsis had resolved in 9/11 (81.8%) patients in cohort I, 5/24 (20.8%) and 1/6 (16.7%) — in cohorts II and III (respectively, p = 0.002).Conclusion. Programmed staged-lavage VAL is an optimal surgical treatment tactics in SPDP. Relative to RD, VAL provides a more effective management of local and systemic abdominal sepsis, lower mortality, fewer and less sever complications, shorter intensive care stays after abdominal closure. |
| first_indexed | 2024-03-07T21:47:06Z |
| format | Article |
| id | doaj.art-10f11cc9b6ca4ee8b8efa9ae4769555b |
| institution | Directory Open Access Journal |
| issn | 1608-6228 2541-9544 |
| language | Russian |
| last_indexed | 2025-03-14T11:27:26Z |
| publishDate | 2022-02-01 |
| publisher | Ministry of Healthcare of the Russian Federation. “Kuban State Medical University” |
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| series | Кубанский научный медицинский вестник |
| spelling | doaj.art-10f11cc9b6ca4ee8b8efa9ae4769555b2025-03-02T10:05:37ZrusMinistry of Healthcare of the Russian Federation. “Kuban State Medical University”Кубанский научный медицинский вестник1608-62282541-95442022-02-01291627610.25207/1608-6228-2022-29-1-62-761301Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trialI. B. Uvarov0D. D. Sichinava1A. M. Manuilov2Kuban State Medical University; Clinical Oncology Dispensary No. 1Kuban State Medical University; Clinical Oncology Dispensary No. 1Kuban State Medical UniversityBackground. Secondary postoperative diffuse peritonitis (SPDP) associates with a high incidence of abdominal sepsis and 35–92% mortality rate. An optimal surgical doctrine in this complication in lacking to date.Objectives. An efficacy assessment of vacuum-assisted laparostomy (VAL) with staged lavage relative to relaparotomy on demand (RD) in SPDP patients.Methods. Patient enrolment and analyses were conducted within period 01.11.2017-31.12.2020, totalling for 141 SPDP patients, 77 (54.6%) males and 64 (45.4%) females aged 64.5 (5972.7) years. Cohort I patients (n = 52) had post-abdominal-lavage VAL using Suprasorb® SNP (SNP-1 and SNP-2) equipment and consumables (Lohmann & Rauscher GmbH, Austria). Staged lavage was performed 48-72 h apart. Cohort II (n = 78) had a standard RD technique. Cohort III (n = 11) treatment included RD-to-VAL transition. The endpoint was the inpatient treatment outcome, a favourable completion or death. The additional estimated criteria were complications rate and severity (in ACCORDION-modified Clavien-Dindo classification), sepsis rate, C-reactive protein level, abdominal index dynamics, patient’s intensive-care and total-hospital lengths of stay.Results. Cohort I included 157 staged-lavage VALs, cohort II — 107 RDs, cohort III — 49 operations. The mortality rate was 3/52 (5.8%), 24/78 (30.8%) and 7/11 (63.6%) in cohorts I, II and III (respectively, p < 0.001). No difference was observed in the length of hospital stay, with a shorter intensive care stay after final abdominal closure in cohort I. Clavien — Dindo grade 3a complications were observed for 25.0% of cohort I, 60.3 and 45.5% — of cohorts II and III (respectively, p < 0.01); grade 3b complications were 0 (0%), 24.4 and 100% in cohorts I, II and III (respectively, p < 0.001; all 11 patients were reoperated). Multiple organ failure (grade 4b) was reported in 5.8, 30.8 and 63.6% of cohorts I, II and III (respectively, p < 0.001). By end of treatment, sepsis had resolved in 9/11 (81.8%) patients in cohort I, 5/24 (20.8%) and 1/6 (16.7%) — in cohorts II and III (respectively, p = 0.002).Conclusion. Programmed staged-lavage VAL is an optimal surgical treatment tactics in SPDP. Relative to RD, VAL provides a more effective management of local and systemic abdominal sepsis, lower mortality, fewer and less sever complications, shorter intensive care stays after abdominal closure.https://ksma.elpub.ru/jour/article/view/2629postoperative peritonitissecondary peritonitisvacuum therapynegative pressure therapylaparostomyopen abdomenstaged peritoneal lavagerelaparotomy on demand |
| spellingShingle | I. B. Uvarov D. D. Sichinava A. M. Manuilov Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trial Кубанский научный медицинский вестник postoperative peritonitis secondary peritonitis vacuum therapy negative pressure therapy laparostomy open abdomen staged peritoneal lavage relaparotomy on demand |
| title | Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trial |
| title_full | Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trial |
| title_fullStr | Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trial |
| title_full_unstemmed | Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trial |
| title_short | Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trial |
| title_sort | vacuum assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis a prospective comparative non randomised clinical trial |
| topic | postoperative peritonitis secondary peritonitis vacuum therapy negative pressure therapy laparostomy open abdomen staged peritoneal lavage relaparotomy on demand |
| url | https://ksma.elpub.ru/jour/article/view/2629 |
| work_keys_str_mv | AT ibuvarov vacuumassistedlaparostomywithstagedperitoneallavageinmanagementofsecondarypostoperativediffuseperitonitisaprospectivecomparativenonrandomisedclinicaltrial AT ddsichinava vacuumassistedlaparostomywithstagedperitoneallavageinmanagementofsecondarypostoperativediffuseperitonitisaprospectivecomparativenonrandomisedclinicaltrial AT ammanuilov vacuumassistedlaparostomywithstagedperitoneallavageinmanagementofsecondarypostoperativediffuseperitonitisaprospectivecomparativenonrandomisedclinicaltrial |